In the 1980s, Lia Lee, a child born to Hmong parents in the Northern California city of Merced, had her first seizure at three months old. She was brought to a community medical center, but there were no Hmong translators to communicate with her parents and explain how to administer her medication properly. And the hospital staff didn’t understand the Hmong spiritual remedies the Lees wanted for their daughter; Hmong shamans were not allowed to perform their rituals in the hospital. Meanwhile, Lia’s condition persisted: By the time she was four-and-a-half years old, she’d been admitted to the hospital 17 times.

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The story of cross-cultural communication breakdown in the Merced medical system is the subject of Anne Fadiman’s widely acclaimed 1997 book, The Spirit Catches You and You Fall Down. The hospital where Lia was treated is now called the Dignity Health Mercy Medical Center Merced, and since the publication of Fadiman’s work, much has changed. Bob McLaughlin, a spokesperson for the hospital, tells Co.Exist that Mercy Medical Center recently invited Fadiman back for a visit. “She told us, ‘I wrote this book because I knew it was an important story; I had no idea that 20 years later, people here would be using it as a textbook.’”

Fadiman’s work was the basis for a novel policy that Mercy Medical Center has introduced to allow Hmong shamans to come into the hospital and perform traditional ceremonies for patients that request them. The shamans, over the course of a six-week training, learn hospital protocols; Mercy Medical doctors and staff are also educated in the Hmong ceremonies.

Hmong families fleeing the Vietnam War first settled in Merced in 1976. With a population of over 7,000, Merced’s Hmong community is the third largest in California, after Sacramento and Fresno.

The Hmong Shaman Visitation Policy–to McLaughlin’s knowledge, the only one of its kind in play at a hospital–outlines nine ceremonies that Hmong shamans are allowed to perform at the patient’s bedside, ranging from a 10-minute chant that’s designed promote healing after loss of blood to a ritual involving tying a red string around the patient’s neck, which is supposed to encourage the body to mend. Sometimes, a shaman will recommend a longer or more involved ceremony, perhaps involving animals or fire; for those rituals, the shaman can negotiate on a case-by-case basis with hospital staff for approval. Janice Wilkerson, who directs the Mission Integration team for Mercy Medical Center, tells Co.Exist that she recalls some more elaborate ceremonies taking place in the hospital’s parking lot.

Integrating the Hmong rituals with the mainstream hospital care at Mercy Medical began, almost by chance, in 1998. A Hmong patient in the hospital was slowly dying; his body was shutting down, and the physicians had done everything they could, Wilkerson says. Marilyn Mochel, a registered nurse at the hospital, and Palee Moua, the wife of a Hmong clan leader, approached the hospital administration to ask, on behalf of the family, if a shaman could be brought on the premises to perform a ceremony for the patient. It would be a fairly protracted ritual, involving long knives, but there was a wing of the hospital that was under construction at the time and mostly empty; the Mercy Medical staff agreed to move the patient there for the ceremony, and bring the shaman in. After the ceremony, the patient’s health turned around. He made a full recovery, and is still active in the Merced Hmong community.

“Physicians experience these ‘miracles’ from time to time,” McLaughlin says, “but this case really illustrated to them the power of these ceremonies. Healing isn’t just about medicine, it’s about people.”

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Mochel and Moua worked with a nonprofit to develop and formalize a training program to facilitate more Hmong shaman hospital visits; the nonprofit began educating shamans in 2000. When funding for the nonprofit began to slip in 2012, McLaughlin and Wilkerson stepped up to fund the program directly through Mercy Medical. To date, almost 140 shamans have gone through the six-week course, and “graduates” of the program reconvene once a month to stay in touch and share learnings.

“Shamans used to be very secretive about their ceremonies; they felt that their culture was not understood,” Wilkerson says. “Now, they come into the hospital with an official badge; they feel they are very much respected and know that we understand that their work is important.”

In turn, the program has strengthened the Hmong community’s trust in mainstream medicine: Shamans are able to communicate with patients who may otherwise be skeptical of hospital procedures. “We see this all the time,” McLaughlin says. “A doctor might want to do a CT scan, but the patient will say, ‘I’m not doing that until the shaman says it’s okay.’ But because the shamans are informed about the equipment and procedures through the course, they’re able to tell the patient that it’s okay—the doctors are trying to help them,” McLaughlin says. Since the policy and program were introduced, Mercy Medical has seen members of the Hmong community coming to the hospital for help right away, as opposed to only when an illness reached crisis point.

Though McLaughlin and Wilkerson say they’ve heard from other medical institutions looking to implement the program, or similar policies with other spiritual practices, they haven’t seen any other initiative really take hold in the same way as the Hmong shaman program. McLaughlin credits the program’s success to the hospitals mission of treating people with dignity and prioritizing humanity. Every time a new employee starts at Mercy Medical, McLaughlin walks them through the policy, and always says the same thing. “What we do here is take care of people: If it’s the right thing for the patient it’s the right thing for us to do.”

[All Images: via Upworthy]

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About the author

Eillie Anzilotti is an assistant editor for Fast Company's Ideas section, covering sustainability, social good, and alternative economies. Previously, she wrote for CityLab.